Permit •
4 CITY OF TIGARD
ELECTRICAL PERMIT
•• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00597 T.
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 2S102CB07600
Jurisdiction: Tigard
Site address: 13155 SW GRANT AVE
Project: Mortenson Subdivision: 2002 -086 PARTITION PLAT Lot: 1
Project Description: Electrical reconnect only
Contractor: Owner: MORTENSEN, TIM & SHANNON
13155 SW GRANT AVE
TIGARD, OR 97223
PHONE
PHONE:
• FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/17/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 10/17/2012 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in acco • - 'th approved plans. This permit will expire if work is not started within 180 days of issua ce, or rf work is suspended for more the 180
days. ATT •• ION: Oregon law' -quires you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
952-001-1 through OAR 95.=!.1-11 = ' You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 987 or 1.800.332.2344.
Issu •d By: r � • Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the Job site at the time of each inspection.
Y ,
,
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: l� a
�7 PermitNo.:��� _(,h �9,
9 13125 SW Hall Blvd., Tigard,OR 97223 Received Plan Review
503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 and 2 family dwelling ❑ CommerciaUindustrial C] Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: % 7/ 100HP or more. occupancy.
S S S G n ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: f (P ArL,/2 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: M, kT / /`-.S aet ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
G y Limited energy, multi - family 75.00 2
JJ
/` C C o�/�,4 r 7 &L- -fief �la'V/CL residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
I4OPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: r•—• / 401 amps to 600 amps 200.34 2
/ / iv) 1 0 ozh ,-S1) 0� 601 amps to 1,000 amps 301.04 2
Address: r3 5' S,.--1 gA,n.Z.- Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: %�/ 6 Art ,( 2 relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only r 67.84 (j/ Z 0 2
Pump or irrigation circle 67.84 `+ 2
E - mail:
Sign or outline lighting 67.84 2
CO TRACTOR Signal circuit(s) or limited - energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%: hr min) 90.00 / hr
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 7 (9
/'
Plan review (25 /o of permit fee):
Print name: Date: State surcharge (12% of permit fee): g tt11 r f 7
' TOTAL PERMIT FEE: 75. $
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: • ; A, �� Date: ( O -/7 / • Number of inspections allowed per permit.
I: \BuildingWermils\ELC -Penn 07/01/10 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
F COMMERCIALNWORK=ONLY:.
Fee for each commercial $75.00
system
• (SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building\Permits\ELC- PermitApp.doc 07/01/10